In our series' final installment, we explore the eight Instrumental Activities of Daily Living (IADLs), essential for maintaining a high-functioning, independent, quality life. While the previous post – 6 ADLs Explained to Get the Senior Care You Need – focused on basic personal care tasks, IADLs encompass more complex activities that require cognitive functioning and organizational skills.
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Here’s a quick example of the intricacies in getting proper nutrition that requires these planning, decision-making, and multiple action steps:
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Deciding what you are going to eat,
Making a list of ingredients to buy,
Going to the store,
Shopping for the items,
Paying for your purchases,
Putting things away when you return home,
Prepping the ingredients,
Following a recipe or knowing the techniques and order to cook the dish(s),
Serving the food,
Cleaning the kitchen when done, and
Putting up leftovers.
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These are arguably a succession of tasks that can even be a challenge for young, able-bodied, and experienced home cooks and chefs. Hence, undertaking each IADL generally requires a lot of thought, observation, decision-making, and judgment. For a variety of reasons, as we age our ability to accomplish these instrumental activities may decline and the need for support will accordingly increase.
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So, let’s explore the eight capabilities evaluated in the Lawton-Brody Instrumental Activities of Daily Living Scale (Lawton-Brody IADL Scale). Download the scale to help evaluate your loved one’s dependency level. The skills summarized below will help you determine how you would rate current performance. Note the list is not exhaustive and principally serves as reference to determine your level of dependence.
IADL #1 – Using communication tools
Skillfully operates communication devices to make calls, manage correspondence, and screen out unwanted contacts, ensuring effective connection with others. To determine the communication rating consider how well you or your loved one can:
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Dial traditional and/or mobile telephone; and hang up when done.
Call friends, family, and well-known contacts.
Hang up on telemarketer and delete scam emails.
Address and send mail and/or email.
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Why communication is important
The inability to communicate with others puts you at risk of isolation and loneliness from being unable to stay connected with family and friends, leading to potential mental health issues like depression and anxiety. Several challenges contribute to communication issues including:
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Physical limitations such as arthritis that make it difficult to dial or type.
Cognitive impairments leading to confusion with technology or forgetting contact information.
Hearing or vision impairments hindering effective communication.
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Ideas to help ensure good communication
Adaptive Tools/Equipment: Specialized telephones with large buttons and screens, voice-activated devices like smart speakers.
Personal Support: Assistance from family members or professional caregivers in setting up and teaching how to use these devices.
Changes to Living Environment: Creating dedicated areas for easy access to communication devices, ensuring good lighting and seating for comfort during use.
IADL #2 – Shopping for goods and services
Demonstrates the ability to plan shopping, select and pay for items efficiently, and organize purchases at home, thus showcasing independence in acquiring necessities. To decide the shopping rating consider how well you or your loved one can:
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Make a list of household supplies, groceries, apparel, and other required and discretionary items.
Select goods and services either in-store or online.
Pay for purchases using available payment methods.
Store materials in a proper place for future retrieval and use.
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Why shopping is essential
The ability to procure food, medications, or other essentials is important to prevent nutritional and health deficiencies that could potentially impact your overall health and quality of life due. Issues that create these challenges include:
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Mobility problems that limit the ability to physically shop in stores or carry items.
Cognitive challenges affecting decision-making, memory, or the ability to navigate online shopping platforms.
Financial difficulties restricting the ability to purchase necessary goods and services.
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Ideas to help them get what they need
Adaptive Tools/Equipment: Online shopping platforms and apps that simplify the purchasing process.
Personal Support: Assistance from caregivers for both online and in-person shopping, including making lists, navigating stores, or handling transactions.
Changes to Living Environment: Organizing transport services for shopping trips or setting up regular delivery services for essentials.
IADL #3 – Preparing meals
Involves planning nutritious meals, shopping for ingredients, following recipes to cook, and managing kitchen cleanup, highlighting self-sufficiency in meal preparation. To pick a meal preparation rating consider how well you or your loved one can:
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Plan daily meals that meet dietary recommendations and provide adequate nourishment.
Check supplies and draft a shopping list for ingredients.
Follow recipe directions for preparing and cooking food.
Serve meals, box up leftovers, and wash dishes, utensils, and cooking equipment.
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Why access to healthy food is good
Malnutrition or reliance on unhealthy, processed foods because you are unable to prepare balanced, nutritious meals could seriously affect physical health and well-being. These factors contribute to meal preparation challenges:
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Physical limitations preventing effective use of kitchen tools or appliances.
Cognitive decline affecting the ability to plan meals, follow recipes, or remember cooking processes.
Sensory changes impacting the ability to taste or smell, leading to disinterest in cooking.
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Ideas to help ensure good food access
Adaptive Tools/Equipment: Ergonomic kitchen tools, easy-open containers, and pre-prepared meal kits.
Personal Support: Meal preparation services or caregivers who can assist in cooking and meal planning.
Changes to Living Environment: Adjusting kitchen layout for accessibility, installing easy-to-use appliances.
IADL #4 – Cleaning and maintaining the residence
Encompasses regular cleaning tasks, basic home maintenance, and yard upkeep to maintain a clean and functional living environment. To rate cleaning capabilities consider how well you or your loved one can:
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Dust, mop, and clean kitchen, bathrooms, and living areas.
Change sheets and make the bed.
Complete low-skill home maintenance projects such as changing light bulbs, batteries, and HVAC filters.
Mow, weed, water, and trim landscaping.
Dispose of trash and clutter appropriately.
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Why keeping up with cleaning chores is crucial
Failure to keep the house clean leads to increased risk of infections, accidents, and health issues due to unhygienic living conditions or hazards in the living environment. Several challenges impact cleanliness including:
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Physical disabilities hindering the ability to perform cleaning tasks or maintenance work.
Lack of energy or motivation, often seen in depression, affecting regular housekeeping.
Cognitive issues causing disorganization or neglect of household maintenance.
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Ideas to help with household cleaning and maintenance
Adaptive Tools/Equipment: Lightweight cleaning tools, robotic vacuums, and mop.
Personal Support: Regular cleaning services or caregivers assigned to household chores.
Changes to Living Environment: Minimizing clutter for easier maintenance and cleaning, possibly downsizing to a more manageable space.
IADL #5 – Doing the laundry
Covers sorting, washing, drying, and organizing clothing and linens, reflecting the ability to maintain personal and household items in a clean state. To determine the laundry rating consider how well you or your loved one can:
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Separate items by color and care instructions.
Wash and dry clothing and household items by hand or machine.
Fold clothing and return items to closets and drawers.
Iron or dry clean, as appropriate.
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Why doing the laundry does good
Wearing unclean clothes or using dirty linens and towels may contribute to social isolation, skin infections, or other health related issues. Things that may prevent someone from doing the laundry include:
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Physical challenges with handling laundry tasks, such as lifting heavy loads or bending.
Cognitive impairments leading to difficulty in sorting clothes or operating machines.
Lack of access to laundry facilities or equipment.
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Ideas to help get the laundry done
Adaptive Tools/Equipment: Front-loading or raised washing machines and dryers, easy-to-use laundry detergent pods.
Personal Support: Laundry service or caregiver assistance with sorting, washing, and folding clothes.
Changes to Living Environment: Moving laundry facilities to the main floor or considering a home renovation for easier access.
IADL #6 – Managing medications
Entails understanding medication purposes, managing prescriptions, and correctly taking medications as prescribed, which is crucial for maintaining health. To decide the ability to manage medications consider how well you or your loved one can:
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Understand the purpose of taking over the counter and prescription drugs.
Fill and refill prescriptions to ensure everything is up to date.
Arrange daily medications to take correct dosage at prescribed frequency.
Consume or inject medicine at the correct time of day; with or without food and beverage, as directed.
Store and dispose of drugs that are outdated or no longer used as recommended.
Monitor health statistics and take appropriate measures.
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Why poor medication management is risky
Adverse health outcomes, including medication errors, overdoses, or failure to treat conditions effectively, potentially cause hospitalizations. Many things contribute to medication risks including:
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Memory deficits resulting in forgetting to take medications or confusion over dosages.
Physical difficulties with opening medication containers or administering doses.
Lack of understanding about the importance or purpose of medications.
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Ideas to help ensure medications are taken correctly
Adaptive Tools/Equipment: Pill dispensers with alarms, medication management apps.
Personal Support: Home health care assistance for medication management or utilizing pharmacy services that pre-sort medications.
Changes to Living Environment: Establishing a dedicated, well-organized area for storing and managing medications.
IADL #7 – Handling finances
Involves budgeting, making payments, managing accounts, and fulfilling tax obligations, indicating competence in financial management. To evaluate the financial management rating consider how well you or your loved one can:
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Make spending budget and balance accounts.
Complete large and small purchases.
Write checks and pay bills on time.
Make deposits and balance accounts.
Track and collect income from multiple sources.
Prepare or have taxes prepared and pay them.
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Why financial management is smart
Financial vulnerability including the risk of fraud and inability to pay for essentials or services, may lead to debt, loss of housing, or inability to access healthcare. These issues contribute to problems handling finances such as:
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Cognitive decline affecting the ability to budget, write checks, or manage accounts.
Physical impairments that make it difficult to visit banks or handle paperwork.
Psychological conditions like depression or anxiety that can lead to neglect of financial responsibilities.
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Ideas to help manage finances
Adaptive Tools/Equipment: Financial management software with user-friendly interfaces, automatic bill pay services.
Personal Support: Financial advisors or trusted family members to assist with budgeting, bill payments, and financial planning.
Changes to Living Environment: Setting up a home office space with easy access to financial records and tools.
IADL #8 – Arranging transportation
Reflects the ability to plan and execute travel, including driving or arranging alternative transportation, essential for maintaining mobility and independence. To pick the transportation rating consider how well you or your loved one can:
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Plan route, drive own car to given location, and park without incident.
Arrange for travel to and from a place by friends and family, public transportation, taxi, or shared ride service.
Access elevator, escalator, ramp, or stairs to get to correct place upon arrival at desired location.
Use cane or walker to assist movement around location.
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Why reliable transportation is important
Inability to arrange travel may lead to decreased access to medical care, social activities, or essential services, could contribute to further physical decline, isolation, and reduced independence. Unreliable transportation may be due to these things:
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Loss of driving ability due to physical or cognitive impairments.
Lack of familiarity or comfort with using public transportation or ride-sharing services.
Social isolation or anxiety preventing the individual from arranging transportation with others.
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Ideas to help with transportation
Adaptive Tools/Equipment: Ride-sharing apps that are senior-friendly and services specialized in transportation for the elderly.
Personal Support: Scheduling with caregivers or family members for transportation needs.
Changes to Living Environment: Living in communities with access to public transportation or senior transport services or relocating to more accessible areas.
Helpful Tool to Evaluate Senior Independence
As we navigate the complexities of aging, understanding and addressing the Instrumental Activities of Daily Living (IADLs) becomes a cornerstone of fostering independence and enhancing quality of life. The ability to manage these tasks is crucial for maintaining not only physical and mental health but also social connections and overall well-being.
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The challenges associated with IADLs can often be mitigated with thoughtful interventions, ranging from the use of adaptive tools and technologies to personalized support and modifications in the living environment. By recognizing the signs of difficulty in these areas, you can take proactive steps to ensure you continue to live as independently as possible, while also safeguarding your health and happiness.
Failure to effectively manage IADLs poses significant risks, including isolation, malnutrition, financial vulnerability, and a decline in physical health. Yet, with the right strategies and supports in place, we can help mitigate these risks, providing a safety net that will allow you to thrive in later years.
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Let this exploration of the eight IADLs serve as a guide to understanding the nuanced needs of the elderly and as an inspiration to seek creative and compassionate solutions.